Leonard Kamen, DO, FAAPMR, FAOCPMR, CAQPM, Clinical Director, Clinical Associate Professor, MossRehab Hospital Outpatient Center, Temple University Hospital Department of PMR
Rehabilitation hospitals (IRFs) in the age of the opioid crisis (OC) have been the healthcare systems recipients of all too many casualties of opioid use disorder (OUD). There were an estimated 2 million people identified with OUD in the US in 2017, of those, up to 130 people die daily from opioid related exposure. For those that survive opioid overdose or other substance abuse poisoning, IRFs and our outpatient units must devise complex rehabilitative strategies. Teams of clinicians are required to cope with anoxic brain trauma, spinal injuries, polytrauma impairments, amputations, septic infections and chronic pain consequent to opioid overdose. IRFs must provide intensive resource management to treat the physical, functional, medical and cognitive sequela of the OC survivors. In addition, we must be prepared to initiate a sophisticated approach to a cohesive recovery process. Admission of an opioid casualty to an IRF may be the watershed moment to unwinding and redirecting the forces that led to these life altering events. We will address the broad demographics of the OC and look at the impact this has had on individuals, families, local communities and healthcare systems including IRFs. This presentation will provide perspective on the neuroscience and behavioral elements of addiction. Opioid use disorder as a chronic brain disease characterized by disturbances in brain reward, motivation, memory and related brain circuitry will be reviewed. Opioid use in the IRF for the painful sequela of trauma or surgery remains fraught with a confusing array of protocols and guidelines. Both undertreatment and overtreatment of pain may unintentionally be the trigger to a substance use disorder in the susceptible individual. Screening tools to assess the potential for addiction or misuse of opioids will be described as this represents a predisposing element to trauma itself further complicating the intricate rehab process. An opioid stewardship program within the IRF may promote safe and effective pain management inclusive of non-pharmacologic, alternatives to opioids. Medication assisted therapy (MAT) for OUD has proven value but may be stigmatized and utilized unevenly in the IRF setting. Several healthcare systems have adopted a warm handoff system that allows for individuals to transition from OUD to MAT with psychosocial and drug counselling. Intensive opioid treatment and office-based therapies will be described. Integration of OUD treatments in the setting of IRFs and rehabilitation hospital-based outpatient clinics are within the IRF mission to demonstrate effective and efficient outcomes for complex neurological and functional impairments. The rehabilitation and recovery process of the survivors of the OC will be reviewed.
- Discuss the unique properties of this class of drugs that have contributed to pain relief, addiction and the opioid epidemic of these last 20 years.
- Explain why opioid and other substance abuse disorders resulting in brain injury, poly-trauma and sophisticated surgical procedures require intensive team resources to affect recovery.
- Describe how multimodal pain management,psychological guidance, novel technology and Medication Assisted Treatment can be integrated into rehab systems & provide support in the opioid crisis.
*Recorded Webinars are eligible for CME and CNE only*
Accreditation Statement - In support of improving patient care, this activity has been planned and implemented by Amedco and American Medical Rehabilitation Providers. Amedco is jointly accredited by the American Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Credit Designation Statement - Amedco designates this webinar for a maximum of 1.0 AMA PRA Category 1 CreditsTM for physicians and 1.0 contact hours for nurses Learners should claim only the credit commensurate with the extent of their participation in the activity.